Vancomycin pharmacokinetics in hydrocephalic shunt prophylaxis and relationship to ventricular volume.

Vancomycin pharmacokinetics were determined in 25 patients receiving ventriculoperitoneal shunts for hydrocephalus. Computed tomography scan-derived ventricular-brain ratio as an expression of hydrocephalus varied between 9.3% and 15.

Distribution of angiographic vasospasm after subarachnoid hemorrhage: implications for diagnosis by transcranial Doppler ultrasonography.

A study was undertaken to determine how frequently angiographic vasospasm occurs outside the normal access range of transcranial Doppler ultrasound in patients who have suffered a subarachnoid hemorrhage. Vasospasm located in the basal vessels is readily identifiable using transcranial Doppler ultrasound whereas spasm affecting the more distal, vertically oriented arteries is outside the standard detection range. It is therefore speculated that the sensitivity of the technique would be adversely affected by a high incidence of distal vasospasm.

Isolated fetal ascites: prenatal diagnosis and management.

The perinatal outcomes of four patients with isolated fetal ascites were evaluated. The ascites disappeared prior to delivery in 50% of the cases and was resolved shortly after delivery in the remainder. Excellent neonatal outcomes were observed.

Xenograft rejection of class I-expressing transgenic skin is CD4-dependent and CD8-independent.

B10.PD1 mice are transgenic animals expressing a class I MHC antigen of pigs. B10.

Postoperative CT contrast enhancement following lobectomy for epilepsy.

Contrast-enhanced computerized tomography (CT) is frequently utilized immediately after surgery to determine the presence of residual tumor, but the response of nontumor brain tissue is unclear. Consequently, the authors investigated the postoperative CT contrast enhancement in six patients undergoing lobectomy for epilepsy. Preoperative CT scans were obtained in all cases and revealed no enhancing lesions.

A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures.

Background: Antiepileptic drugs are commonly used to prevent seizures that may follow head trauma. However, previous controlled studies of this practice have been inconclusive.

Methods: To study further the effectiveness of phenytoin (Dilantin) in preventing post-traumatic seizures, we randomly assigned 404 eligible patients with serious head trauma to treatment with phenytoin (n = 208) or placebo (n = 196) for one year in a double-blind fashion.

Xenogeneic proliferation and lymphokine production are dependent on CD4+ helper T cells and self antigen-presenting cells in the mouse.

We studied proliferation and interleukin 2 production by B6 mouse spleen cells in response to stimulation by irradiated cynomolgus monkey spleen cells and compared the results with responses against whole MHC-disparate allogeneic controls (BALB/c). We found that (a) primary xenogeneic helper responses were absent, whereas primary allogeneic responses were brisk, (b) secondary xenogeneic helper responses were dependent on CD4+ T cells and responder antigen-presenting cells (APCs), whereas allogeneic responses could be mediated by either CD4+ or CD8+ T cells independently and were primarily dependent on the presence of stimulator APCs, and (c) secondary xenogeneic helper responses were blocked by an antibody directed against responder class II MHC molecules. These results suggest that mouse helper T cells recognize disparate xenoantigens as processed peptides in association with self class II MHC molecules, similar to the recognition of nominal antigens and unlike direct allo-recognition.

Tuberculosis of the skull--a rare condition: case report and review of the literature.

A 25-year-old woman exhibited swelling of the scalp and a bony defect of the skull from which Mycobacterium tuberculosis was cultured. The case is reported, and the literature is reviewed.

Does pregnancy alter the rate of progression of diabetic nephropathy?

The effect of gestation on the rate of decline in renal function was studied in 11 pregnancies complicated by diabetic nephropathy. For each pregnancy, serum creatinine levels were available within 4 years before pregnancy, during pregnancy, and within 4 years after delivery. Although all of these patients were hypertensive and had increased proteinuria during pregnancy, the mean serum creatinine just prior to conception (1.

Transcranial Doppler in cerebral vasospasm.

Transcranial Doppler provides a noninvasive method for recording blood flow velocity (and indirectly, diameter) in the basal cerebral arteries and therefore is especially useful in detecting vasospasm following subarachnoid hemorrhage. Vasospasm most commonly involves the basal arteries, where the changes in vessel diameter will be inversely proportional to the mean velocity measurements. Examination of patients requires that the examiner be experienced and familiar with the vascular anatomy and the various TCD indicators of vasospasm.

Sonographic assessment of growth of the fetal head in diabetic pregnancies compared with normal gestations.

A longitudinal ultrasound study was conducted in 45 insulin-dependent diabetic patients who maintained good glycemic control (mean plasma glucose less than 120 mg/dl) throughout most of their pregnancy in order to assess growth of the fetal head in the presence of euglycemia. Patients with and without vasculopathy were found to be comparable with regard to their glycemic control, medical and obstetric complications, as well as incremental growth and the velocity of growth of the fetal biparietal diameter (BPD). When compared with the control group, the velocity of growth of the BPD was not significantly different throughout pregnancy.

Hypersomatotropism in pregnant women, as measured by a human liver radioreceptor assay.

Radioreceptor assays (RRAs) provide useful information about the bioactivity of peptide hormones. We have developed a RRA for human GH using membranes prepared from human liver. The assay has 1% cross-reactivity with human PRL, 0.

Murine CD8+ T cell helper function is particularly sensitive to cyclosporine suppression in vivo.

In order to investigate the mechanism of action of cyclosporine (CsA) in vivo the drug was used to prolong the survival of different types of allogeneic skin grafts on mice under different conditions. Lower doses of CsA were necessary to prolong class I-disparate grafts than to prolong class II-disparate grafts than to prolong whole MHC-disparate grafts. Second set skin grafts, even of class I-only disparity, could not be prolonged even by higher doses of CsA.

Ultrasonographic criteria for the prenatal diagnosis of placental chorionicity in twin gestations.

Thirty-two patients with uncomplicated twin pregnancies had ultrasonographic examinations for genetic amniocentesis, confirmation of twinning, or assessment of fetal growth. The dividing membranes between the fetuses were visualized, and the thickness of the membranes was measured. With a thickness of 2 mm used as a cutoff point, the accuracy in predicting monochorionic or dichorionic twinning was 82% and 95%, respectively.

Acute subdural hematomas: an age-dependent clinical entity.

Reports prior to 1980 describe overall mortality rates for acute subdural hematomas (SDH's) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. A relatively large number of older patients (34 patients over 65 years old) were treated recently at Harborview Medical Center, enabling a retrospective comparison with similarly treated younger patients (33 patients aged 18 to 40 years).

Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage.

Angioplasty of narrowed cerebral arteries was performed in 10 patients who became symptomatic from vasospasm following subarachnoid hemorrhage. This procedure was accomplished with a microballoon catheter via percutaneous transfemoral insertion. Patients were selected for treatment if they had delayed neurological deficits due to vasospasm which were not responsive to hypervolemic hypertensive therapy.

Studies on natural killer (NK) cells IV NK-3.1: a new NK cell specific alloantigen.

A new murine natural killer (NK) cell alloantigen, NK-3.1, has been identified by analysis of the complement dependent anti-NK cell activity of C3H anti-ST and BALB/c anti-DBA/2 alloantisera. Flow cytometric studies with a specific antiserum made in backcross mice indicate that this alloantigen is expressed by 2-3% of the spleen cells of NZB and C57BL/6 mice, positive strains, but is undetectable on the spleen cells of C3H mice, a negative strain.

Interrelationship between insulin, dietary fiber, and exercise in the management of pregnant diabetics.

The metabolic changes during pregnancy are characterized as "accelerated starvation" and "facilitated anabolism" which are, in turn, worsened by the presence of diabetes mellitus. The current roles of dietary fiber and exercise as adjunctive therapeutic modalities in the management of diabetic pregnancies are discussed herein.

In vivo use of monoclonal antibodies against murine T cell antigens.

Experiments were performed seeking conditions for the optimum use of anti-T cell monoclonal antibodies in vivo in mice. Anti-L3T4 (CD4) and anti-Lyt2 (CD8) antibodies of different subclasses (IgG2b, IgG2a, and IgM) and species (rat or mouse) were used. The results showed that (i) intraperitoneal compared to intravenous administration of the different antibodies achieved the same serum levels whether in the presence or absence of the recipient's thymus; (ii) repeated treatment with a rat IgM anti-L3T4 or a rat IgG2b anti-Lyt2 antibody was followed by inability to detect serum levels of each antibody; (iii) in vivo treatment with these antibodies caused target cell lysis, target antigen masking without cell destruction, or target antigen modulation without cell destruction and the particular effect of a given antibody could not be predicted by its isotype or specificity; (iv) neither the C5 component of complement nor antibody-dependent cell-mediated cytotoxicity mediated the action of GK1.

Xenogeneic skin graft rejection is especially dependent on CD4+ T cells.

B6 mice were treated in vivo with anti-CD4, anti-CD8, or both anti-T cell antibodies together in an effort to prolong xenogeneic compared with allogeneic skin graft survival. Mice treated with anti-CD4 antibody showed prolonged survival of xenogeneic monkey or rabbit skin even after they had rejected whole MHC-disparate allogeneic mouse skin. Furthermore, the addition of cyclosporine was synergistic with the anti-CD4 antibody in prolonging graft survival.